中国实用外科杂志

中国实用外科杂志 ›› 2022, Vol. 42 ›› Issue (12): 1436-1440.DOI: 10.19538/j.cjps.issn1005-2208.2022.12.18

• 文献综述 • 上一篇    

急性肠系膜缺血性疾病诊疗进展

董晓宇1，2，李沛雨2，郗洪庆2   

  1. 1中国人民解放军医学院，北京100853；2中国人民解放军总医院第一医学中心普通外科医学部，北京100853
  • 出版日期:2022-12-01 发布日期:2022-12-27

  • Online:2022-12-01 Published:2022-12-27

摘要： 急性肠系膜缺血性疾病（AMI）是一种危重的外科急腹症。AMI发病早期十分隐匿，多以腹痛为首发症状，典型表现为剧烈的疼痛与轻度的腹部体征分离现象，早期诊断较为困难，早期的CT血管成像（CTA）已经取代血管造影成为AMI诊断的金标准。但AMI缺血一旦到达晚期，则会出现不可逆性肠坏死。AMI在发病后6 h内及时得到救治，病死率会降至10%～20%，目前我国尚无明确的AMI诊疗指南，一经确诊后AMI的治疗分为保守治疗、腔内治疗及开放手术，而在预后方面我国尚无相关方面的随访报告，因此，对于AMI的早期确诊及采取适合的治疗措施对于此类急性重症病人的救治显得格外重要。

关键词: 急性肠系膜缺血性疾病, 不可逆性透壁性肠坏死, 早期诊断, 治疗策略

Abstract: Progress in diagnosis and treatment of acute mesenteric ischemia diseases        DONG Xiao-yu*, LI Pei-yu,Xi Hong-qing. *Medical School of Chinese PLA，Beijing 100853，China；Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Corresponding authors：XI Hong-qing, E-mail:xihongqing@126.com;LI Pei-yu,E-mail:lipeiyu6301@163.com
Abstract    Acute mesenteric ischemic disease (AMI) is a critical surgical emergency. Early onset of AMI is very insidious, mostly with abdominal pain as the first symptom; typically characterized by severe pain and mild abdominal signs separation phenomenon; early diagnosis is difficult.Early CT angiography (CTA) has replaced angiography as the gold standard for the diagnosis of AMI. Once AMI ischemia reaches an advanced stage,irreversible intestinal necrosis will occur. Six hours after the onset of AMI timely treatment; the morbidity and mortality rate will be reduced to 10%-20%; there are no clear AMI standardized treatment guidelines; once diagnosed AMI treatment is divided into conservative treatment；interventional therapy and open surgery; and in terms of prognosis; there is no relevant follow-up report. Therefore, the early diagnosis of AMI and the appropriate treatment measures are particularly important for the treatment of these acute and critical patients.

Key words: acute mesenteric ischemia, irreversible transmural intestinal necrosis, early diagnosis, treatment strategies